Home Health Medicare Certification and State Licensure Forms and Resources

Home Care

An entity operating as a certified/licensed home health agency must offer two skilled services on an intermittent basis, one of which must be skilled nursing.

 Guidelines for Development - Medicare Certified and State Licensed Home Health Agnecy

 Letter of Intent for State Licensure and/or Medicare Certification

 Application for Home Health Agency License

 State Disclosure of Ownership and Control Interest Statement

Office for Civil Rights Packet Information

 Assurance of Compliance (Title VI or Civil Rights Act)

 Health Insurance Benefit Agreement

 197.400 - 197.478 RSMo Home Health Agencies

 19 CSR 30-26.010 Home Health Licensure Rule

42 CFR 484.10 - 484.20 Conditions of Participation: Home Health

Alzheimer's and Dementia Specific Training - 660.050

 Interpretive Guidelines - Home Health Agencies (State Operations Manual-Appendix B)

 Patient Rights (42 CFR 484.10)

Criminal Background - 660.317

Family Care Safety Registry

 Advance Directive Information - 42 CFR 489.100-489.104

 MO Law Regarding a Patient's Right to Make Health Care Treatment Decisions

 Possession of Drugs by a HHA or Hospice - 4 CSR 220-2.010(8)

Hepatitis B - 29 CFR 1910.1030(f)(1), (i)(ii),(ii)(A),(2)(iv)

 OASIS and HAVEN Help Resources

Home Health Advance Beneficiary Notice (HHABN)